Clinical echocardiographic electrocardiographic and chest radiographic characteristics of patients admitted at Muhimbili National Hospital medical wards with Nyha III-IV heart failure

Abstract

Background: Heart failure is a major public health problem in developed countries, imposing a huge burden on their health care systems. In Africa, improvements in the control of communicable diseases and the migration to the cities with changes in life styles, cardiovascular diseases such as hypertension with consequence heart failure are increasingly recognized as significant causes of morbidity and mortality. Most of the published data on heart failure is based on work in Caucasian populations within the developed world, and data on its incidence, prevalence, etiology, treatment, and outcome in Africa are lacking. Objective:The aim of this study was to describe the cl inical,echocard iograph ic,electrocard iographic and chest rad iograph ic characteristics of patients admitted at Muhimbili National Hospital medical wards with NYHA III/IV heart failure. Materials and Methods: A cross section study was done for three months in 2008. During this period, a total of 100 patients with severe heart failure were evaluated clinically. All had thorough clinical history, standard resting transthoracic echocardiograms, resting 12 lead electrocardiograms, and standard postero anterior chest radiograms taken and data analysed. Results: PND was a symptom which occurred to all the patients. Other most frequently occurring features included positive hepatojugular reflux, Elevated Jugular Venous pressure, tender hepatomegally and nocturnal cough. Dilated Cardiomyopathy was the most frequent echocardiographic diagnosis (28%), chronic rheumatic valvular disease was the second most frequent diagnosis (23%), left ventricular hypertrophy without LV dilatation (19%) and Isolated LV dilatation (18%). Fifty four (54%) patients had significant LV systolic dysfunction (LVEF<30%) and 9% had grade one LV diastolic dysfunction. Pulmonary Hypertension was found in 39% of the patients. The most frequently dilated chambers were the LA (58%) and LV (56%) respectively.

VI Conclusions: 1. PND was a common symptom to all the patients. Other most frequently occurring features included positive hepatojugular reflux, Elevated Jugular Venous pressure, tender hepatomegaly and nocturnal cough. 2. The most common echocardiographic finding of patients in this study was dilated cardiomyopathy followed by chronic rheumatic valvular disease. Left ventricular systolic dysfunction was the most common form of heart fai lure (54%).Left atrial dilatation was the most frequently dilated cardiac chamber, confirmed by both the ECG and Echo. 3. Sinus tachycardia was the most frequent Arrhythmias (47%), left atrial and right atrial abnormalities accounted for 42% and 7% respectively, 22% of patients had BBB, and 46% had L VH with secondary ST - T changes. Majority (76%) of patients had more than one ECG abnormalities. 4. Cardiomegaly was the most common radiographic finding accounting for 87%.Seventy six (76%) patients had interstitial oedema of varying severity and 12% had pleural effusion.

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